Introduction: To evaluate the patient reported outcomes of Primary Direct visual internal urethrotomy (DVIU) and Non-transecting bulbar urethroplasty techniques (NTBU) for short segment ( <2 cm) Non Traumatic bulbar urethral strictures using the Modified Urethral Stricture Surgery Patient Reported Outcome Measures (USS PROM).
Methods: The USS PROM questionnaire comprising of a six-item LUTS domain, a LUTS-specific QOL question, and a Peeling’s voiding picture score was further modified by adding a six-item IIEF and four-item version of MSHQ-EjD to evaluate Erectile and Ejaculatory domains. All cases of short non traumatic bulbar urethral stricture who underwent primary DVIU and NTBU who consented were asked to fill the modified PROM (USS -PROM+ IIEF +MSHQ-EjD) at initial evaluation , at 6 months and at 1 year.
Results: The LUTS score for NTBU at 12 months is significantly better (p=0.000). The Peeling score of the NTBU is significant better at 6 months (p=0.000) and 12 months ( p=0.000). Erectile function score at 12 months for NTBU is significantly better than DVIU ( p=0.001). The Ejaculatory function score at 6 months and 12 months is significantly better for the NTBU. Uroflowmetry (Qmax) is significant in NTBU group at 12 months (p =0.000). ROC AND Odd’s Ratio analysis for analyzing patient satisfaction showed Erectile function (AUROC-0.889, p<0.001), Ejaculatory function (AUROC-0.957, p<0.001) at 1 year and Qmax (AUROC-0.928,p < 0.001) at 6 months and (AUROC-1.000,p < 0.001) at 1year. Overall satisfaction rates in patients undergoing NTBU is 96.5%.
TABLE 2-Statistical Analysis Of Variables:
URETHROPLASTY
(N=29)
Mean ±SD
VIU
(N=24)
Mean ±SD
P VALUE
LUTS score
BASELINE
16.90 ± 5.1
16.63 ±4.4
0.879
6 MONTHS
3.31 ± 2.14
5.54 ± 5.88
0.605
1 YEAR
1.93 ± 2.13
8.76 ± 5.92
0.000
Peeling voiding picture
score
BASELINE
3.41 ± 0.56
3.46 ± 0.50
0.838
6 MONTHS
1.59 ± 0.56
2.26 ± 0.96
0.007
1 YEAR
1.41 ± 0.68
2.67 ± 0.73
0.000
Erectile function score
BASELINE
19.37 ± 3.45
18.25 ± 2.38
0.181
6 MONTHS
23 ± 3.63
22.16 ± 3.43
0.398
1 YEAR
24.37 ± 3.2
21.143 ± 2.86
0.001
Ejaculatory function score
BASELINE
11.31 ± 2.2
10.58 ± 1.12
0.165
6 MONTHS
13.41 ± 1.18
12.33 ± 1.49
0.005
1 YEAR
14.00 ± 1.0
11.76 ± 1.78
0.000
Ejaculatory function- bother/satisfaction score
BASELINE
2.28 ± 1.36
2.21 ± 0.83
1.000
6 MONTHS
1.00 ± 0.75
1.33 ±0.86
0.165
1 YEAR
0.55 ± 0.68
1.57 ± 0.87
0.000
Qmax
BASELINE
5.03 ± 1.20
4.48 ± 1.70
0.192
6 MONTHS
25.81 ± 2.83
18.55 ± 4.15
0.000
1 YEAR
26.7 ± 4.08
15.35 ± 5.16
0.000
Conclusions: NTBU shows superior outcomes in almost all domains of USS- PROM with better overall satisfaction rates. Improvement of Sexual function domain followed by the LUTS domain were the best predictors of overall patient satisfaction and improvement in the quality of life at one year.
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